Regenerative Medicine For Aging Skin   Introduction   Current regenerative therapies available for skin aging are reviewed.   After all, with so many advances in medicine, if our skin is aging faster than we are, then we have got to give it a hand.   Disclaimers   The following is heavily based on a review of the current medical literature. Minimizing opinion, passion does present itself here and there briefly.   Discussion   What can you do for your aging skin instead of lasers and extensive surgery? First a couple of important principles.  
  • Mesenchymal stem cells = adult stem cells that can turn into fibroblasts
 
  • (accent on ‘adult’ stem cells; this is not a discussion of embryonic stem cells, please bear that in mind)
 
  • There are adult stem cells that can turn into keratinocytes
 
  • And keratinocytes and fibroblasts are responsible for elastin and collagen, key to maintaining skin youth, especially collagen three
  Our stem cells, circulating in most tissues, age and diminish as we age. So if our skin is aging, and our stem cells responsible for generating new hair and skin are aging, seems like we are in a bit of a bind.   Fortunately, the reason our bodies respond less and less to our own stem cells and our own growth factors is not as much because our tissues are becoming unresponsive, but more so because our stem cells are becoming less in number and less effective. Our circulating stem cells are aging perhaps faster than we are aging.   Even more fortunately, it turns out that our bodies will respond to outer sources of stem cells quite favorably, be they autologous (our own cells) or allogenic (the cells of another member of our species). Even xenographic sources like from snail can lead to promising results, too.   So, although we can’t really supplement skin too easily... We can sure supplement stem cells and stem cell factors and growth factors.   Luminosity, depth, evenness, lightening, brightening, elasticity, even this thing called beautiful. We all want these in our skin. So as we dive into skin and the concepts involved in it’s aging, let’s start with, the skin organ itself. Sorry, the science part. I’m going to keep it simple, but I’m going to give you what doctors know, because you are entitled to this.   Skin: 2 components, dermis and epidermis. Dermis, one of the big niche areas of stem cell existence in the body no doubt because of the increased turnover there like in the gut, provides stem cells and growth factors and stem cell factors for the epidermis which claws into the dermis in the appearance of a bear claw histologically (the appearance of tissues under the microscope) in younger skin. This bear claw reaching in anatomy is lost in older skin allowing these two sheets of tissue, epidermis over dermis, to just slide over each other because they are flat on flat. Leading to increased sagging, increased sloughing, and increased bruising because the dermis carries blood, we get aged looking and behaving skin.   The particular area of the dermis that contains the most stem cells is the base of the hair follicles, a famous niche area of stem cell preponderance in the body – that is until we start aging. Specifically, it’s the dermal papillae cells at the base of the hair follicle that is the most important to skin and hair maintenance if not regeneration.   So, what if supplementing stem cells locally could lead to stem cells getting directly to these areas automatically. And what if when they get there they could automatically tell that area what to do, even though they were from outside sources.   They can. And they do. Stem cells get there automatically. And... They can tell the area what to do automatically once they get there, even though they are outsiders. These computer-like cells, the adult stem cells, are not rejected even as outsiders because they are immuno privileged. This confuses a lot of people. But, this much has been studied well. And they are so immuno privileged, there is some research and ongoing use of them in host rejection diseases (kidney transplants, like that).   So, we can get mesenchymal adult stem cells from outside donors, specifically umbilical cord structures. And we can get adult mesenchymal stem cells from our own fat. We have the technology to easily and safely extract them our own marrow and fat and deploy them so we can provide our skin such stem cells today. “We have the talent, we have the tools.“ We have the technology. But it requires a little training (OK, so it is a bit of a laborious surgical process, and it must be done in a closed system, meaning we must keep all of this free of infection, but such care is readily available).   So, if supplementary stem cells containing the potential for regeneration and supplementary growth factors from any number of sources help the stem cells work on the skin, then supplementing these should reduce the incidence of if not treat sagging, sloughing, and skin aging in general. Skin creams that contain Xenograft versions of these like snails cells providing stem cells and snail secretions providing growth factors, work well. But deployment in much larger amounts from umbilical stem cell distributors and fat extraction of your own stem cells from your love handles delivered by IV as well as locally help the skin much more so. Think rocket fuel instead of premium gas.   Skin creams get the growth factors and stem cell factors from snail secretions. Skin creams get their stem cells from snail eggs. Not sure what the snail cell counts are. But, you can get healthy, safe human mesenchymal stem cells from FDA approved distributors of umbilical sources in the 1-60 million range. And here’s the best news... You can get your own stem cells from your own fat (with the help of a stem cell surgeon trained in mini-liposuction) in the hundreds of millions.   That’s the cellular part of it. For the human growth factors, we use platelet rich plasma (PRP) easily and safely extracted from your own blood as our greatest source of growth factors. After all, platelets are a little sacks without nuclei containing all the growth factors necessary to help fix tissue. It stands to reason that the stem cells we supplement will need plenty of PRP around to allow the stem cells to do the most they can for us. When it comes to skin at least, stem cells need PRP, PRP needs stem cells.   So in summary, or if I didn’t make it clear, the follicle papillae cells for hair and fibroblasts and keratinocytes for skin work best under the guidance of plenty of stem cells. And supplementing stem cell numbers (especially if you are aging and don’t have enough) is effective therapy. Stem cells can get to those areas automatically if deployed locally, and produce instructions to those areas and cells automatically. Platelets in PRP contain growth factors that help stem cells function and help follicle papillae cells, keratinocytes, and fibroblasts function. But the platelets in PRP don’t get to these areas automatically unless there are plenty of stem cells to guide them in.   The final result from the stem cells and these growth factors, regardless of the source, human or snail, is what we need. Plenty of elastin. Plenty of collagen, type III collagen being the most common type in the skin.   Conclusion   Adult stem cells are critical to regenerate keratinocytes and fibroblasts. These younger keratinocytes and fibroblasts AND stem cells will work better with plenty of growth factors and plenty of stem cell factors.  
  • Growth factors repair and protect, so are considered the extrinsic agent in this formula for skin improvement
  • Stem cells are the intrinsic agent, so they replenish and restore
  So, once again the recurring theme of combination therapy seen in so much of the body reshaping, recontouring, reforming, modalities being used today from body sculpting to tissue regeneration... When you’re talking about skin care... Stem cells (human adult mesenchymal stem cells from your fat or someone else’s umbilical blood versus snail eggs in topical preparations) must team up with growth factors (PRP providing platelets, little sacks filled with growth factors, if you want to be the source, snail secretions if you’re considering skin creams). Both types of sources are spectacular care and recommended by great physicians. For...   As skin ages, it not only loses thickness, it loses the corrugated interface it has between the dermis and the epidermis. Sloughing, sagging, easy bruising follows.   This is just what the body does. And I for one have grown to respect that.   As such... This is not a world of wound healing. Aging isn’t a wound anyway. It’s a blessing.   And this isn’t a world of disease curing. Aging isn’t a disease anyway. And stem cells and growth factors and stem cell factors do not make aging stop. They only make new tissue start. And they prevent old tissue from getting into trouble.   This is a world of tissue and organ regeneration. We know for fact that if adults mesenchymal stem cells are used, it’s completely safe. And the FDA has cleared us to say this. So we all must learn about it together. These are our tissues. Let’s learn about ourselves... Our property… Our adult stem cells... Treating ourselves. Let’s not let anybody take them away as we do.   Stay well, David Allingham, MD, MS